Women Aren’t Just Underdiagnosed. Are We Being Undertreated Too?

We've spent years talking about women being underdiagnosed.

Women whose heart attacks weren't recognized.

Women who waited years for an endometriosis diagnosis.

Women whose pain was dismissed.

Women told their symptoms were anxiety.

That conversation matters.

But new research forces us to ask another uncomfortable question:

What happens after a woman finally gets the diagnosis?

Because receiving the correct diagnosis doesn't necessarily mean the healthcare disparity ends there.

What if women are sometimes receiving different treatment too?

Are women treated differently from men in healthcare?

A recent systematic review examined studies comparing treatment received by women and men with the same health conditions.

Across 38 patient-record studies included in the review, 33 reported significant sex differences in treatment.

The differences appeared across multiple areas of medicine, including cardiovascular disease, kidney disease and neurological conditions.

Women were sometimes less likely to receive certain procedures, interventions or medications.

That's worth paying attention to.

But it's also important to understand what research like this can—and cannot—tell us.

Does this prove doctors intentionally discriminate against women?

No.

Observed differences in treatment don't automatically tell us why those differences occurred.

Clinical decisions can legitimately differ between two patients based on factors such as:

• disease severity

• age

• other medical conditions

• contraindications

• patient preferences

• pregnancy status

• medication interactions

• procedural risk

A treatment difference isn't automatically evidence of bias.

But when differences repeatedly appear across large groups of patients—and aren't readily explained by clinical recommendations—that becomes something healthcare systems should investigate.

That's the nuance I think this conversation deserves.

We shouldn't ignore disparities.

We also shouldn't oversimplify their causes.

This isn't only a diagnosis problem

Imagine a woman finally gets the answer she's been searching for.

She advocated for herself.

She went back to the doctor.

She asked for another opinion.

She completed the testing.

She got diagnosed.

We often treat that moment like the finish line.

But it's really the beginning of another set of questions:

Was she offered the full range of evidence-based treatments?

Were the risks and benefits explained?

Was she referred to the appropriate specialist?

Was her pain treated appropriately?

Was she given the same opportunity to choose an intervention?

Diagnosis is only useful if it leads to appropriate care.

We have seen treatment gaps in cardiovascular medicine

Cardiovascular disease provides an important example.

Research has repeatedly identified sex differences in cardiovascular treatment.

A systematic review of coronary heart disease literature found that many included studies reported lower use of pharmacological treatments, invasive procedures or rehabilitation among women.

More recent 2026 research examining lipid-lowering therapy has also reported differences in treatment patterns between women and men.

Again, individual treatment decisions need individual context.

But repeated population-level patterns deserve investigation.

Why might treatment disparities happen?

There probably isn't one explanation.

Healthcare disparities can emerge from multiple levels of the system.

Clinical research

If women have historically been underrepresented in certain areas of research, clinicians may have less sex-specific evidence available.

Disease presentation

Some diseases can present differently across sexes, potentially affecting recognition and treatment pathways.

Clinical guidelines

Guidelines evolve alongside evidence. If evidence gaps exist, recommendations may not fully address sex-specific differences.

Healthcare access

Insurance, income, caregiving responsibilities, transportation and specialist availability can all influence whether someone receives treatment.

Patient preferences

Patients may make different decisions after receiving information about risks and benefits.

Implicit bias

Healthcare professionals are human beings operating within broader social systems. Assumptions about pain, risk, symptoms or treatment preferences can potentially influence clinical decisions.

These factors can overlap.

Which is why reducing the entire women's-health gap to:

“Doctors don't listen to women.”

may capture some women's lived experiences, but it doesn't fully explain the systemic problem.

Women were historically treated as complicated research subjects

There's an uncomfortable history behind this.

For decades, biomedical research often centered male bodies.

Female hormonal cycles were sometimes treated as variables that made research more complicated.

Pregnancy introduced additional ethical and safety considerations.

The result was that evidence generated primarily in men could sometimes become the foundation for medicine applied to everyone.

We've improved.

But we're still dealing with the consequences of evidence gaps.

The solution isn't to assume women and men always require different medicine.

The solution is to study when biological sex matters—and when it doesn't.

Biological sex and gender aren't the same variable

This conversation gets even more nuanced because both sex and gender can influence healthcare.

Biological factors can influence:

• pharmacokinetics

• hormones

• body composition

• disease prevalence

• symptom presentation

• treatment response

Gender-related factors can influence:

• healthcare access

• social roles

• caregiving responsibilities

• communication

• clinician assumptions

• whether symptoms are believed

• treatment preferences

Researchers need to understand both.

Because a disparity can have biological, social, structural or mixed causes.

“Advocate for yourself” can't be the entire solution

I say this as someone who constantly encourages women to understand their bodies and ask better questions:

Self-advocacy matters.

Ask what your diagnosis means.

Ask what your options are.

Ask why a treatment is being recommended.

Ask what alternatives exist.

Ask what happens if you wait.

Ask when you should follow up.

But I've also started thinking about how much responsibility we place on women when we say:

“You just have to advocate for yourself.”

What about the woman who doesn't have a biomedical engineering degree?

What about the woman who doesn't know which test to ask for?

What about the woman working two jobs who can't research her diagnosis for six hours before an appointment?

What about someone whose first language isn't English?

What about the woman who doesn't know she wasn't offered an option?

Patients should be empowered.

But healthcare shouldn't require every woman to become an expert negotiator.

Questions I want women to feel comfortable asking

You don't need to walk into an appointment ready for a fight.

But you are allowed to ask:

What are all of my treatment options?

What would you recommend, and why?

Are there other evidence-based options we haven't discussed?

What are the risks and benefits of each?

What happens if this treatment doesn't work?

When should we reassess?

Would you refer me to a specialist?

Is there a guideline you're using to make this recommendation?

Those aren't confrontational questions.

They're healthcare questions.

Women's health research can't stop at reproductive organs

This may be the biggest point I want to make.

When people hear women's health, they often think:

Periods.

Pregnancy.

Fertility.

Menopause.

Vaginas.

Those things matter enormously.

But women's health also means:

Heart disease.

Kidney disease.

Neurological disease.

Autoimmune disease.

Cancer.

Pain.

Medication response.

Mental health.

Every area of medicine includes women.

The women's-health gap therefore isn't one specialty's problem.

It's a healthcare-system problem.

Frequently Asked Questions

Are women more likely to be undertreated?

Research has identified sex differences in treatment across several medical conditions, often with women receiving certain interventions less frequently. The size and cause of disparities vary by condition and healthcare setting.

Does different treatment always mean discrimination?

No. Treatment can appropriately differ based on clinical factors and patient preferences. Population-level disparities require analysis to determine whether differences are clinically justified.

What is gender bias in healthcare?

Gender bias can occur when gender-related assumptions or stereotypes influence medical research, diagnosis, treatment or communication. Biological sex differences and gender-related social factors should be distinguished when studying healthcare disparities.

How can women advocate for themselves medically?

Ask about your diagnosis, available treatment options, risks and benefits, alternatives, follow-up plans and when specialist referral is appropriate.

Why were women historically underrepresented in medical research?

Multiple historical, regulatory and ethical factors contributed, including concerns around pregnancy and reproductive risk and the perception that hormonal variability complicated research.

Giana's Take

I will always teach women to advocate for themselves.

Understand your body.

Ask questions.

Get the second opinion.

Learn what your diagnosis means.

But there's something uncomfortable about telling women:

“You just need to advocate harder.”

Because eventually we have to ask why receiving appropriate healthcare requires so much advocacy in the first place.

A woman shouldn't need to know the clinical guideline better than the healthcare system treating her.

She shouldn't need the perfect vocabulary to have her pain taken seriously.

And getting diagnosed shouldn't be considered a success if she never receives an appropriate conversation about treatment.

Empowered patients matter.

But the ultimate goal should be healthcare systems that don't require extraordinary patient empowerment just to deliver ordinary evidence-based care.

That's the women's-health conversation I want us having next.